Medi-Cal/Medicaid Patient Account Representative

Tahoe Forest Health System
Any Location, NV
Category Finance
Job Description
Responsible for submitting accurate claims, ensuring timely reimbursement from various third-party payers and patients, and confirming proper documentation occurs in the facilities’ billing system. Collaborates with Revenue Cycle departments and third-party payers on efforts related to follow-up, denials, and appeals.

Requirements

  • Is Responsible for all Medi-cal/Medicaid and Managed Medicaid plan billing and follow up.
  • Examines denied and underpaid claims to determine reasons for discrepancies.
  • Communicates via phone calls and web-portals, directly with payers to follow up on outstanding claims, resolves payment variances, and achieves timely reimbursement.
  • Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing Accounts Receivables (A/R).
  • Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, in order to identify and report billing compliance issues and payer discrepancies.
  • Participates in quality improvement efforts on an ongoing basis.
  • Understands and maintains compliance with HIPAA guidelines when handling patient information.
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